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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390314809
Report Date: 03/08/2022
Date Signed: 03/09/2022 07:10:07 AM


Document Has Been Signed on 03/09/2022 07:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:O'CONNOR WOODS ASSISTED LIVINGFACILITY NUMBER:
390314809
ADMINISTRATOR:LEAL-MALLETE, PENNYFACILITY TYPE:
741
ADDRESS:3334 WAGNER HEIGHTS RDTELEPHONE:
(209) 956-3400
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:499CENSUS: 298DATE:
03/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Maria BrownTIME COMPLETED:
02:35 PM
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Licensing Program Analyst Bruce Jacobs conducted an unannounced visit to the facility to review and discuss an incident report submitted to the Department by the facility. The report provided details involving the missing items of a resident. The report was discussed with the Administrator and LPA obtained additional details as well as the actions the facility has taken. The facility discovered the resident's items were missing, reported to Licensing, reported to the family who reported to Law Enforcement. The facility conducted an internal investigation including a search of the resident's room, interview of facility staff and health agency staff and cooperation with Law Enforcement. As of this date, the missing jewelry items have not been recovered and the facility is working with the family to resolve the issue. It was determined the facility was following their theft and loss plan.

Exit interview conducted and no deficiencies were identified on this visit.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce JacobsTELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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